Liver Neoplasms Flashcards Preview

Gastrointestinal System > Liver Neoplasms > Flashcards

Flashcards in Liver Neoplasms Deck (26):
1

  • Tumor-like condition
  • Unknown etiology
  • MC in women
  • Usually asymptomatic
  • Small
  • Central stellate scar

Focal nodular hyperplasia

2

  • MC in young adult women; strongly associated with oral contraceptives
    • Also with anabolic steroids, glycogen storage diseases
  • Benign epithelial tumor (on otherwise healthy liver)
    • Small risk of malignant transformation, bleeding; need to excise
  • Typically solitary
  • Clinical
    • Epigastric
    • RUQ pain
  • AFP normal

Hepatic adenoma

3

  • MC benign hepatic tumor 
    • Often asymptomatic
    • No malignant potential
  • Most diagnosed at 30-50 years of age
  • MC in woman 

Cavernous hemangioma

4

Rare, high-grade neoplasm of endothelial cells

MC sarcoma arising in the liver

Older patients (>60); M>F

Risk factors:

  1. Vinyl chloride
  2. Arsenic
  3. Anabolic steroids

Clinical:

  • Abdominal pain
  • Fatigue
  • Weight loss
  • Liver failure (common cause of death)
  • Intra-abdominal bleed (common cause of death)
  • Metastasis common (lungs, bone, adrenals)

Angiosarcoma

5

Name the (3) risk factors for angiosarcoma. 

  1. Vinyl chloride
  2. Arsenic
  3. Anabolic steroids

6

MC primary hepatic malignancy in early childhood (<5 y/o)

M>F

Associated with Down syndrome, FAP

May grow rapidly; can rupture and bleed

AFP markedly elevated

Sexual precocity may be present (extopic synthesis of gonadotropin)

Hepatoblastoma

7

MC primary malignant tumor of liver

Increasing incident in US due to hepatitis C

M>F

U.S. - 60s; Asians - 20s-40s (HBV at birth)

Commonly develops secondary to chronic liver disease (most have cirrhosis)

Hepatocellular carcinoma (HCC)

8

Risk factors for hepatocellular carcinoma (HCC)

(6)

  1. Chronic HBV, HCV
  2. Aflatoxin (grains, Aspergillus)
  3. Chronic alcohol abuse
  4. Fatty liver disease
  5. Hereditary hemochromatosis
  6. Alpha-1-antitrypsin deficiency

9

HCC frequently diagnosed late because of the absence of pathognomonic symptoms. As a result, many patients have untreatable disease when 1st diagnosed; survival measured in months. 

Poor prognostic factors include (3): ___, ___, ___

  1. Increasing tumor size
  2. Vascular invasion
  3. Nodal metastases

10

Well-differenciated HCC cells may produce ___

Bile (creating yellow pigment)

11

Grossly, HCC may present as (3)

  1. Single mass
  2. Multiple, widely distributed nodules
  3. Diffusely infiltrative

12

HCC paraneoplastic syndromes (3)

  1. Hypoglycemia
    • High metabolic needs of tumor
    • Secretion of insulin-like growth factor
  2. Erythrocytosis
    • Tumor secretion of EPO
  3. Hypercalcemia
    • Tumor secretion of PTHrP

13

HCC MC metastasizes to the ___

Other sites include (3)

Lungs (MC)

Other sites:

  1. Intra-abdominal LN
  2. Bone
  3. Adrenal gland

14

___ is a tumor marker for HCC

  • Normally produced during gestation (by fetal liver and yolk sac)
  • Not specific; not specific (not all tumors secrete; normal levels with fibrolamellar variant of HCC)
  • Rise + cirrhosis/chronic hepatitis = worrisome for HCC
  • Not used for screening; may be used for example in a known cirrhosis patient

 

Alpha-fetoprotein (AFP)

15

Other than cirrhosis, a patient can develop portal HTN with HCC growth impacting the ___ or ___, both causing obstruction and portal HTN. 

Portal vein

Hepatic vein/IVC

16

  • Distinctive liver tumor that differs clinically, histologically, and molecularly from conventional HCC
  • Affects younger patients
  • F > M (think young females)
  • Not associated with cirrhosis or chronic viral hepatitis
  • In general, has better prognosis than conventional HCC
  • Tumor is slow growing
  • Patients present with abdominal mass or pain
  • Serum AFP levels usually normal

Fibrolamellar varient of HCC

17

  • Adenocarcinoma of the bile ducts (epithelial cells)
  • Can involve any portion of the biliary tree
    • Intrahepatic - 10%
    • Perihilar (central) - 60%
      • Klatskin's tumor (tumor arises at bifurcation of R and L hepatic ducts)
    • Distal extrahepatic - 30%
  • Highly lethal

Cholangiocarcinoma

18

Predisposting factors to cholangiocarcinoma are chronic inflammatory conditions of the biliary tree, including (5)

  1. Primary sclerosing cholangitis (MC; longstanding UC)
  2. Chinese liver fluke, Opisthorchis (Clonorchis) sinensis  
  3. Choledochal cyst
  4. Caroli disease
  5. Choledocholithiasis

19

Jaundice, pruritis, clay-colored stools, dark urine, abdominal pain, fever. 

Extrahepatic or intrahepatic cholangiocarcinoma?

Extrahepatic (entire biliary tree will be blocked)

20

Dull RUQ pain, weight loss, less likely to be jaundice

Extrahepatic or intrahepatic cholangiocarcinoma?

Intrahepatic (won't obstruct then entire biliary tree, thus won't cause, at least as much, jaundice)

21

Cholangiocarcinoma lab include:

Typically ___ pattern with transaminase levels being ___

  • Cholestatic
  • Initially normal (may increase if long-term obstruction causes hepatocellular injury)

22

Dianosis of cholangiocarcinoma?

  1. US
  2. MRI/CT
  3. ERCP

23

Tx of cholangiocarcinoma?

Surgery 

Biliary stent

24

Prognosis of cholangiocarcinoma?

Poor

25

MC liver tumor is ___; common sites include (4)

Metastasis from another location (multple masses); common sites include:

  • Lung
  • Colon
  • Pancreas
  • Breast

26

With liver metastasis, ascites can become present by one or two ways: ___, ___

  1. Portal HTN
  2. Concomitant peritoneal tumor seeding